Consent & Competency With Alzheimer's

Alzheimer's disease is a brain disorder that affects thinking, reasoning, speaking, behavior and normal day-to-day living. As the disease progresses, a person's mind becomes less and less functional. Because of this, many Alzheimer's patients are not competent to consent to medical procedures that affect their care.

Alzheimer's Disease

• According to the Alzheimer's Association, Alzheimer's disease currently afflicts over
  5.3 million Americans. The number of those with the disease is increasing annually as the population ages. As baby boomers age, the prevalence of Alzheimer's disease will increase quickly. The number of cases of Alzheimer's disease will probably double by the year 2020. The burden on families of these people and the health care system will be huge as one out of every eight baby boomers most likely will develop Alzheimer's disease.

Consent

• Doctors must get the informed consent of patients they are taking care of before starting any treatment. They are obligated to do this by law and medical ethics. Any information must be given to a competent patient who is permitted to make a voluntary choice. When this person does not have the competence to make a valid decision about his treatment, alternate persons to make decisions must be found. The dilemma is the determination of whether patients are competent to make decisions or not. This can be most difficult in patients with Alzheimer's disease.

Capacity

• Making valid healthcare decisions requires that a person has a certain level of "capacity" to make such decisions. Capacity in the case of Alzheimer's disease means that the individual must understand the important risks, benefits and other options available to the proposed plan of care. He must be able to make and communicate his health care decisions. A person who can do these things can make a valid decision regarding approval or rejection of his health care treatment.

Planning

• Because of the prognosis of a person with Alzheimer's disease, it is important to have a discussion about the importance making basic legal and financial plans as part of the plan of treatment as soon as possible after the diagnosis of Alzheimer's disease has been made. The person with Alzheimer's disease should choose a health care proxy to act on his behalf when he no longer has the capacity to give his consent for medical treatment. This is called invoking the health care proxy. Make sure the person with Alzheimer's disease makes his wishes known before he does not have the capacity to do so.

Recommendations

• A doctor or other qualified health care professional should do an initial assessment of the person with Alzheimer's disease and write down the results. The assessment should include daily functioning, which involves bathing, dressing, going to the bathroom, being able to feed yourself and mobility, as well as being able to manage finances and medications. Also the mental status using a reliable test should be recorded. Monitor the person with Alzheimer's disease to see if there are any significant changes present, especially if there is a sudden change in thinking ability or behavior. Reassessment should be done a minimum of every six months. When sudden changes are noted an immediate trip to the doctor is a must.